Told Medicare Will Stop Paying for Rehab?
When coverage is ending but you believe your loved one still needs skilled care, it can be hard to know what to do next. GuideWell Patient Advocates helps families understand Medicare and Medicare Advantage denials, review their options, and navigate the appeal process.
Facing a deadline? Request your appeal by the deadline on your notice, even if we haven’t connected yet.
Filing Your First Fast Appeal
If Medicare is ending coverage for your loved one’s stay in a skilled nursing facility, you can request a fast appeal yourself. This includes Medicare Advantage plans. Here’s who to call, what to have ready, and how to explain your concerns.
1. Find your notice and check the deadline
Look for a form called the Notice of Medicare Non-Coverage (NOMNC). It lists when coverage will end, the number to call, and your appeal deadline. Request your fast appeal by noon the day before the coverage end date listed on the notice.
2. Call the number on your notice
Call the review organization listed on your notice, called the BFCC-QIO. Have the notice, the patient’s Medicare number, and the facility’s name ready.
You can start by saying: “I’d like to request a fast appeal because I disagree with the decision to end Medicare coverage.”
3. Explain why skilled care is still needed
Describe the nursing care or therapy your loved one still needs. Give specific examples and explain why a nurse or therapist is needed to provide that care safely.
Ask the care team for records or a statement supporting those needs. You don’t need a perfect speech or every record before calling to request the appeal.
4. Write down what happens next
Before hanging up, ask for your case number, how to send supporting information, and when to expect a decision. Write down any deadlines and keep copies of everything you submit.
5. Read the decision carefully
If the appeal is denied, another review may be available. Check the decision notice right away for instructions, deadlines, and information about when you may become responsible for costs.
Personalized Appeal Support
You can reach out at any stage, whether coverage is about to end or an appeal has already been denied. We’ll discuss your situation and help you decide what level of support makes sense.
Appeal Strategy Session
For families who want personalized guidance while handling the appeal themselves. We review relevant notices and available records, discuss your options, and provide a written summary of recommended next steps.
Hands-On Appeal Support
For families who want more help with the process. Support may include reviewing nursing and therapy records, preparing appeal materials, and communicating with the facility. We agree on the services, appeal stages, and fees before work begins.